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AAPC Community Wiki: Radiculopathy ICD 10 HELP

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Radiculopathy ICD 10 HELP

I work for a pain clinic and am confused whether to use M51.16 Intervertebral disc disorder with radiculopathy, lumbar region or M54.16 Radiculopathy, lumbar region for a patient with radicular pain that is scheduled for an epidural steroid injection. My doctors are using one or the other diagnosis codes and sometimes both at the same time. In the ICD 10 book M51.16 excludes lumbar radiculitis and M54.16 includes lumbar neuritis and excludes intervertebral disc disorders. Is both M51.16 and M54.16 include radiculitis when scheduled for an Epidural Steroid injection?

ICD-10 code M51.16 states "with radiculopathy." If the patient has intervertebral disc displacement with just lumbago and not radiculopathy there is the code selection M51.26 Other intervertebral disc displacement, lumbar region.

If the physician believes the radiculopathy is attributable to the disc displacement, then the correct code selection is M51.16. The ICD-10 code M51.16 specifically states with radiculopathy. The ICD-10 Official Guidelines for Coding and Reporting states that "signs or symptoms" that are due to a definitive diagnosis are not additionally coded. These guidelines and the code descriptor needs to be reviewed with the physician. If the patient has radiculopathy without a definitive diagnosis then radiculopathy can be coded. It there is established diagnosis such as lumbar disc displacement with associated radiculopathy then only one code is reported. You need to presented to the physician that there is an element of correct coding, that it is incorrect to select M54.16 and M51.16 if the purpose of that selection is to state the patient has disc displacement with radiculopathy.

5. Conditions that are an integral part of a disease process Signs and symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.

18. Use of Sign/Symptom/Unspecified Codes
Use of Sign/Symptom/Unspecified Codes Sign/symptom and ?unspecified? codes have acceptable, even necessary, uses. While specific diagnosis codes should be reported when they are supported by the available medical record documentation and clinical knowledge of the patient?s health condition, there are instances when signs/symptoms or unspecified codes are the best choices for accurately reflecting the healthcare encounter. Each healthcare encounter should be coded to the level of certainty known for that encounter.
If a definitive diagnosis has not been established by the end of the encounter, it is appropriate to report codes for sign(s) and/or symptom(s) in lieu of a definitive diagnosis. When sufficient clinical information isn?t known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate ?unspecified? code (e.g., a diagnosis of pneumonia has been determined, but not the specific type). Unspecified codes should be reported when they are the codes that most accurately reflect what s known about the patient?s condition at the time of that particular encounter. It would be inappropriate to select a specific code that is not supported by the medical record documentation or conduct medically unnecessary diagnostic testing in order to determine a more specific code.

AHA Coding Clinic 1989

Title: Excludes notes under diagnosis codes 723 and 724

Body:
Question:

Please clarify the"Excludes" notes under 723 and 724.Do these "Excludes" notes mean that conditions due to intervertebral disc disorders or spondylosis are included in codes 721.0--722.9 or do both conditions need to be coded?

Answer:

Symptoms and signs associated with (due to) spondylosis and allied disorders, 721.0--721.91, or intervertebral disc disorders (such as slipped disc or arthritic degeneration of intervertebral disc), 722.0--722.93, are included in the 721--722 code series.

Examples

? Sciatica, 724.3, due to a slipped or degenerative intervertebral disc is included in the 722 category.

? Pain or neuritis due to spondylosis or intervertebral disc disorder is included in the 721--722 categories.

? Spinal stenosis due to degeneration (arthritic) of the intervertebral disc is classified to the 722 category, while spinal stenosis, congenital or NOS, is classified within the 723--724 categories.

AHA Coding Clinic 1994

Issue: Third

Title: Clarification - excludes notes under categories 723/724

Body:
Clarification of Excludes Notes under categories 723 and 724

Question:

A patient is admitted for surgical therapy because of chronic low back pain, which is presumed secondary to herniated intervertebral disc. A lumbar myelogram reveals lumbar disc herniation without myelopathy and lumbar spinal stenosis. The physician is queried and states, "The lumbar spinal stenosis is due to bony impingement." However, the physician denies the presence of spondylosis and cannot determine whether the spinal stenosis is congenital or acquired. Since the lumbar spinal stenosis is not attributable to the herniated disc, although it is an associated finding, is it appropriate to assign two codes 722.10, Displacement of lumbar intervertebral disc without myelopathy, and 724.02, Lumbar spinal stenosis?

Answer:

Assign code 722.10, Displacement of lumbar inter-vertebral disc without myelopathy, and code 724.02, Lumbar spinal stenosis, since the physician has stated that the lumbar stenosis is not attributable to the herniated disc.

Below is from the ICD-10 manual they state radiculitis due to lumbar disc disorders (M51.1) has Excludes1 note that M54.1 code should not used at the same time.
_______________________

"An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note"

___________________________________________

"With"
The word "with" should be interpreted to mean "associated with" or "due to" when it appears in a code title...

Excludes Notes: The ICD-10-CM has two types of excludes notes. Each type of note has a different definition for use but they are all similar in that they indicate that codes excluded from each other are independent of each other.

a. Exclude1 A type 1 Excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes 1 is used when two conditions cannot occur together such as a congenital form versus an acquired form of the same condition.

b. Exclude 2 A type 2 Excludes note represent "Not included here" An excludes 2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both condition at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.

Below is from the ICD-10 manual they state radiculitis due to lumbar disc disorders (M51.1) has Excludes1 note that M54.1 code should not used at the same time.
_______________________

"An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note"

___________________________________________

"With"
The word "with" should be interpreted to mean "associated with" or "due to" when it appears in a code title...

Excludes Notes: The ICD-10-CM has two types of excludes notes. Each type of note has a different definition for use but they are all similar in that they indicate that codes excluded from each other are independent of each other.

a. Exclude1 A type 1 Excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes 1 is used when two conditions cannot occur together such as a congenital form versus an acquired form of the same condition.

b. Exclude 2 A type 2 Excludes note represent "Not included here" An excludes 2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both condition at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.

Could you clarify then for me what you would do in the case of Lumbar disc displacement with radiculitis, since M51.1 has an Excludes1 note indicating "lumbar radiculitis M54.16" prompting us to consider that code instead? Would I then need to use the intervertebral disc disorder without radiculopathy code PLUS the lumbar radiculitis code M54.16?
Herein lies the problem for me: In those same Excludes1 notes, there is no mention of excluding thoracic, thoracolumbar, or lumbosacral radiculitis. What would my instruction be here?

Jessica, with for example M51.16 lumbar disc disorder with radiculopathy or M51.17 lumbosacral disc disorder with radiculopathy. The instructions state:

"A Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note"

So "radiculopathy with cervical disc disorder (M50.1), "radiculopathy lumbar and other intervertebral disc disorder (M51.1), or "radiculopathy with spondylosis" (M47.2-) are all definitive diagnoses that have the symptom "radiculopathy" with the condition that is the culprit for that symptom (disc displacement/disorder, spondylosis) in one code.

What they are saying is if you have symptom with definitive condition (all-in-one) code, you are not going to relay to the payer they have radiculopathy with say M54.16 or M54.17 because the fact that radiculopathy is present is relayed in the codes such as M51.16, M51.17, M47.26, M47.27.

With"
The word "with" should be interpreted to mean "associated with" or "due to" when it appears in a code title...

As with ICD-9 you would not report 721.0 cervical spondylosis without myelopathy and then add 336.8 for myelopathy when there is a single code describing the present of myelopathy. They have expanded the with or without myelopathy designation in ICD-10 to encompass with or without radiculopathy.

So if you have lumbar or lumbosacral disc displacement with lumbago only you would code M51.26 or M51.27. If the provider stated there was associated radiculopathy then you would simply chose the disc disorder/displacement code the includes radiculopathy in the code descriptor such as M51.16 or M51.17.

You can see the carriers such as Medicare understand M51.16 or M51.17 include radiculopathy with disc displacement when you review for example WPS Medicare J5 LCD for epidurals> They stress the presence of a radicular component with conditions such as disc displacement or spondylosis and ICD-10 codes that meet medical necessity include M51.16 M51.17 M47.26 M47.27 but not the without radiculopathy codes such as M51.26 M51.27 M47.816 M47.817

I was told by my coding mentor when you use code the M51.1 set of codes you must also use the disorder code example "M51.2, M51.3" as the M51.1 set of codes does not specify the disorder it just states they have a disorder that is causing Radiculopathy.

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